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Invited Commentary |

Improving Use of the “Other” Catheter Comment on “Reducing Inappropriate Urinary Catheter Use”

Michelle Mourad, MD; Andrew Auerbach, MD
Arch Intern Med. 2012;172(3):260-261. doi:10.1001/archinternmed.2011.622.
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The duration of urinary catheterization is the most important risk factor for catheter-associated urinary tract infection (CAUTI).1 Thus, best-practice guidelines recommend both limiting the number of patients who receive a urinary catheter, and promptly removing it when it is no longer indicated in patients who must receive it.2

Despite the apparent simplicity of these guidelines, programs seeking to reduce CAUTI have to overcome well-defined barriers involving health care providers, including (1) lack of knowledge of the criteria for appropriate urinary catheter use; (2) failure to recognize that a urinary catheter is present, particularly if the catheter was placed elsewhere; and (3) failure to remove the catheter at the appropriate time. Bedside placards, computer reminders, and automatic stop orders have been tried as approaches to improve urinary catheter use. There is substantial evidence supporting the effectiveness of these techniques, termed in combination the bladder bundle.3 Despite the success of these interventions, clinical implementation of these practices remains low. Urinary catheter reminders or a stop order to prevent CAUTI are used in fewer than 1 in 10 US hospitals.4 These findings speak to the complexity of translating these best practices into successful, sustainable interventions.

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